CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France.
CHU de Clermont-Ferrand, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France.
Orthop Traumatol Surg Res. 2020 Nov;106(7):1425-1431. doi: 10.1016/j.otsr.2020.06.011. Epub 2020 Oct 10.
Failure rates for screw fixation in femoral neck fracture in young patients are often high, with risk of aseptic femoral head osteonecrosis and non-consolidation. The present study sought to identify factors for success or failure of internal fixation according to: 1) initial treatment; 2) initial reduction quality; and 3) population characteristics.
The study hypothesis was that population, fracture type, initial treatment and reduction quality can predict survival.
A retrospective study included all cases of femoral neck fracture in under 65-years-old treated by screwing in our center: i.e., 112 patients. Patient characteristics, time to surgery were collated; surviving patients were followed up at a minimum 24 months. Reduction quality was assessed on X-rays in 3 dimensions and cervico-diaphyseal angle.
Mean follow-up was 5.3±3.0 years [range, 2.0-13.6 years]. At 2 years, 23 of the 112 patients (20.5%) had developed complications: 10 osteonecroses (8.9%) and 13 non-unions (11.6%). Known hip osteonecrosis risk factors showed no significant association with survival. Failure rates were significantly higher in unstable (Garden≥3) than stable (Garden≤2) fracture: HR=2.77 [95%CI: 1.09-7.02]; p=0.025. There was no significant association with time to treatment (≤6 hours): HR=1.08 [95%CI: 0.46-2.54]; p=0.86. On 2-year radiographs, mean shortening on the z-axis was 12.3±4.8mm [-0.7 to 26.2], 8.5±5.0mm [-6.8 to 23.9] on the x-axis, and 6.4±6.1mm [-6.3 to 25.3] on the y-axis. There was a significant negative correlation between z shortening and HOOS pain component (r=-0.38; p=0.005), a non-significant negative correlation with quality of life (r=-0.20; p=0.16), and a significant negative correlation with sports activity (r=-0.28; p=0.039).
The present series showed lower rates of complications and of arthroplasty than in the literature. Internal fixation seemed to be indicated even at an interval of 6 hours or more.
IV, retrospective study.
年轻患者股骨颈骨折螺钉固定的失败率通常较高，存在无菌性股骨头坏死和不愈合的风险。本研究旨在根据以下因素确定内固定的成功或失败因素：1）初始治疗；2）初始复位质量；3）人群特征。
本研究假设人群、骨折类型、初始治疗和复位质量可以预测存活率。
回顾性研究纳入了在我院接受螺钉治疗的所有 65 岁以下股骨颈骨折患者：共 112 例患者。记录患者特征和手术时间；对存活患者进行至少 24 个月的随访。通过三维 X 线评估复位质量和颈干角。
平均随访时间为 5.3±3.0 年[范围：2.0-13.6 年]。在 2 年时，112 例患者中有 23 例（20.5%）出现并发症：10 例股骨头坏死（8.9%）和 13 例骨折不愈合（11.6%）。已知的髋关节骨坏死风险因素与存活率无显著相关性。不稳定型（Garden≥3）骨折的失败率明显高于稳定型（Garden≤2）骨折：HR=2.77[95%CI：1.09-7.02]；p=0.025。与治疗时间（≤6 小时）无显著相关性：HR=1.08[95%CI：0.46-2.54]；p=0.86。在 2 年的 X 线片上，Z 轴平均缩短 12.3±4.8mm[-0.7 至 26.2]，X 轴缩短 8.5±5.0mm[-6.8 至 23.9]，Y 轴缩短 6.4±6.1mm[-6.3 至 25.3]。Z 轴缩短与 HOOS 疼痛成分呈显著负相关（r=-0.38；p=0.005），与生活质量呈非显著负相关（r=-0.20；p=0.16），与运动活动呈显著负相关（r=-0.28；p=0.039）。
本系列研究结果显示并发症和关节置换率低于文献报道。即使在 6 小时或更长时间后，内固定似乎也是可行的。
IV，回顾性研究。
